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Cardiovascular assessment of falls in older people

Lookup NU author(s): Dr Maw Tan, Professor Rose Anne Kenny


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Falls in older people can be caused by underlying cardiovascular disorders, either because of balance instability in persons with background gait and balance disorders, or because of amnesia for loss of consciousness during unwitnessed syncope. Pertinent investigations include a detailed history, 12-lead electrocardiography, lying and standing blood pressure, carotid sinus massage (CSM), head-up tilt, cardiac electrophysiological tests, and ambulatory blood pressure and heart rate monitoring, which includes external and internal cardiac monitoring. The presence of structural heart disease predicts an underlying cardiac cause. Conversely, the absence of either indicates that neurally mediated etiology is likely. CSM and tilt-table testing should be considered in patients with unexplained and recurrent falls. Holter monitoring over 24 hours has a low diagnostic yield. Early use of an implantable loop recorder may be more cost-effective. A dedicated investigation unit increases the likelihood of achieving positive diagnoses and significantly reduces hospital stay and health expenditure.

Publication metadata

Author(s): Tan MP, Kenny RA

Publication type: Review

Publication status: Published

Journal: Clinical Interventions in Aging

Year: 2006

Volume: 1

Issue: 1

Pages: 57-66

Print publication date: 01/01/2006

ISSN (print): 1176-9092

ISSN (electronic): 1178-1998



DOI: 10.2147/CIA.S